Revisiting and old friend - pimecrolimus

K. A. Papp MD, PhD

Probity Medical Research

KAP is a consultant, investigator, speaker and advisory board member for

• Astellas• GSK• Leo• Valeant

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Warning

some content may not be suitable to all audiences

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CyA

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Pimecrolimus (Elidel) SDZ ASM Macrolactamisolated from Streptomyces hygroscopius var. ascomyceticusworks through the FK-BP-12 inhibiting the dephosphorylation of NF-AT

Grassberger M, Steinhoff M, Schneider D, Luger TA. Exp Dermatol 2004

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BJD 2005

Pbo, 10, 20, 30 mg b.d. x 12 weeks

Mean % change pasi from baseline3.1%

22.2%51.3%54.0%

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BJD 2005

Pbo, 10, 20, 30 mg b.d.Mean % reduction EASI wk 12

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Optimizing AD Therapy with TCIsLatest Clinical Trial-2015

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• PIM 1% BID, emollient BID as needed

• Age group ≥3–<12 months

• Two arms: Pimecrolimus (n = 1205) & TCS (n = 1213)

• Open-label, randomized, parallel group 5 yr

Long-term efficacy of PIM compared with TCS- Face

Sigurgeirsson and al.; Safety and Efficacy of Pimecrolimus in Atopic Dermatitis: A 5-Year Randomized Trial; PEDIATRICS Volume 135, number 4, April 2015 13

Concomitant use with steroids

Pimecrolimus is associated with a steroid-sparing effect• PIM group used TCSs for a median of only 7 days compared with 178

days in the other group. • 36% of patients in PIM group did not use any TCS

CHILDREN

Off Label

Do not try this at home

We are professionals with speciallized training

Off label use• Bhardwaj SS, Jaimes JP, Liu A, et al. A double-blind

randomized placebo-controlled pilot study comparing topical immunomodulating agents and corticosteroids for treatment of experimentally induced nickel contact dermatitis.Dermatitis. 2007 Mar;18(1):26–31.

• Katsarou A, Armenaka M, Vosynioti V, et al. Tacrolimus ointment 0.1% in the treatment of allergic contact eyelid dermatitis. J Eur Acad DermatolVenereol. 2009 Apr;23(4):382–7.

• Belsito D, Wilson DC, Warshaw E, et al. A prospective randomized clinical trial of 0.1% tacrolimus ointment in a model of chronic allergic contact dermatitis. J Am Acad Dermatol. 2006 Jul;55(1):40–6.

• Alomar A, Puig L, Gallardo CM, et al. Topical tacrolimus 0.1% ointment (protopic) reverses nickel contact dermatitis elicited by allergen challenge to a similar degree to mometasone furoate 0.1% with greater suppression of late erythema. Contact Dermatitis. 2003 Oct;49(4):185–8.

• Mensing CO, Mensing CH, Mensing H. Treatment with pimecrolimus cream 1% clears irritant dermatitis of the periocular region, face and neck. Int J Dermatol. 2008 Sep;47(9):960–4.

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• Allergic Contact Dermatitis

Off label use• Tzung TY, Liu YS, Chang HW.

Tacrolimus vs. clobetasol propionate in the treatment of facial cutaneous lupus erythematosus: a randomized, double-blind, bilateral comparison study. Br J Dermatol. 2007 Jan;156(1):191–2.

• Barikbin B, Givrad S, Yousefi M, et al. Pimecrolimus 1% cream versus betamethasone 17-valerate 0.1% cream in the treatment of facial discoid lupus erythematosus: a double-blind, randomized pilot study. Clin Exp Dermatol. 2009 Oct;34(7):776–80.

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• Cutaneous Lupus

Off label use• Corrocher G, Di Lorenzo G, Martinelli N, et al.

Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus. J Clin Periodontol. 2008 Mar;35(3):244–9.

• Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral SurgOral Med Oral Pathol Oral Radiol Endod. 2008 Feb;105(2):187–93.

• Laeijendecker R, Tank B, Dekker SK, et al. A comparison of treatment of oral lichen planuswith topical tacrolimus and triamcinoloneacetonide ointment. Acta Derm Venereol. 2006 86(3):227–9.

• Gorouhi F, Solhpour A, Beitollahi JM, et al. Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus. J Am AcadDermatol. 2007 Nov;57(5):806–13.

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• Lichen Planus

Off label use• Hengge UR, Krause W, Hofmann H, et

al. Multicentre, phase II trial on the safety and efficacy of topical tacrolimusointment for the treatment of lichen sclerosus. Br J Dermatol. 2006 Nov;155(5):1021–8.

• Nissi R, Eriksen H, Risteli J, et al. Pimecrolimus cream 1% in the treatment of lichen sclerosus. Gynecol ObstetInvest. 2007 63(3):151–4.

• Arican O, Ciralik H, Sasmaz S. Unsuccessful treatment of extragenitallichen sclerosus with topical 1% pimecrolimus cream. J Dermatol. 2004 Dec;31(12):1014–7.

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• LSA

Off label use • Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

• Lebwohl M, Freeman AK, Chapman MS, et al. Tacrolimus ointment is effective for facial and intertriginous psoriasis.J Am Acad Dermatol. 2004 Nov;51(5):723–30.

• Ortonne JP, van de Kerkhof PC, Prinz JC, et al. 0.3% Tacrolimus gel and 0.5% Tacrolimus cream show efficacy in mild to moderate plaque psoriasis: Results of a randomized, open-label, observer-blinded study. Acta DermVenereol. 2006 86(1):29–33.

• Liao YH, Chiu HC, Tseng YS, et al. Comparison of cutaneous tolerance and efficacy of calcitriol 3 microg g(-1) ointment and tacrolimus 0.3 mg g(-1) ointment in chronic plaque psoriasis involving facial or genitofemoralareas: a double-blind, randomized controlled trial. Br J Dermatol. 2007 Nov;157(5):1005–12.

• Clayton TH, Harrison PV, Nicholls R, et al. Topical tacrolimus for facial psoriasis. Br J Dermatol. 2003 Aug;149(2):419–20.

• Yamamoto T, Nishioka K. Topical tacrolimus: an effective therapy for facial psoriasis. Eur J Dermatol. 2003 Sep-Oct;13(5):471–3.

• Rallis E, Nasiopoulou A, Kouskoukis C, et al. Successful treatment of genital and facial psoriasis with tacrolimus ointment 0.1%. Drugs Exp Clin Res. 2005 31(4):141–5.

• Martin Ezquerra G, Sanchez Regana M, Herrera Acosta E, et al. Topical tacrolimus for the treatment of psoriasis on the face, genitalia, intertriginous areas and corporal plaques. J Drugs Dermatol. 2006 Apr;5(4):334–6.

• Freeman AK, Linowski GJ, Brady C, et al. Tacrolimus ointment for the treatment of psoriasis on the face and intertriginous areas.J Am AcadDermatol. 2003 Apr;48(4):564–8.

• Bissonnette R, Nigen S, Bolduc C. Efficacy and tolerability of topical tacrolimus ointment for the treatment of male genital psoriasis. J CutanMed Surg. 2008 Sep-Oct;12(5):230–4.

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• Psoriasis

Off label use • Elewski BE. Safe and effective treatment of seborrheic dermatitis. Cutis. 2009 Jun;83(6):333–8.

• Meshkinpour A, Sun J, Weinstein G. An open pilot study using tacrolimusointment in the treatment of seborrheic dermatitis. J Am Acad Dermatol. 2003 Jul;49(1):145–7.

• Braza TJ, DiCarlo JB, Soon SL, et al. Tacrolimus 0.1% ointment for seborrhoeic dermatitis: an open-label pilot study. Br J Dermatol. 2003 Jun;148(6):1242–4.

• Warshaw EM, Wohlhuter RJ, Liu A, et al. Results of a randomized, double-blind, vehicle-controlled efficacy trial of pimecrolimus cream 1% for the treatment of moderate to severe facial seborrheic dermatitis. J Am AcadDermatol.2007 Aug;57(2):257–64.

• Firooz A, Solhpour A, Gorouhi F, et al. Pimecrolimus cream, 1%, vshydrocortisone acetate cream, 1%, in the treatment of facial seborrheicdermatitis: a randomized, investigator-blind, clinical trial. Arch Dermatol. 2006 Aug;142(8):1066–7.

• Rallis E, Nasiopoulou A, Kouskoukis C, et al. Pimecrolimus cream 1% can be an effective treatment for seborrheic dermatitis of the face and trunk. Drugs Exp Clin Res. 2004 30(5–6):191–5.

• Koc E, Arca E, Kose O, et al. An open, randomized, prospective, comparative study of topical pimecrolimus 1% cream and topical ketoconazole 2% cream in the treatment of seborrheic dermatitis. J Dermatolog Treat. 2009 20(1):4–9.

• Cicek D, Kandi B, Bakar S, et al. Pimecrolimus 1% cream, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel in the treatment of seborrhoeic dermatitis: a randomized clinical study. J Dermatolog Treat.2009 20(6):344–9.

• Papp KA, Papp A, Dahmer B, Clark CS. Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 15 ointment compared with tacrolimus 0.1% ointment in adults. J Am Acad Dermatol. 2012, 67(1): e11-5

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• Seborrhea

Off label use

• Passeron T, Ostovari N, Zakaria W, et al. Topical tacrolimusand the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004 Sep;140(9):1065–9.

• Kawalek AZ, Spencer JM, Phelps RG. Combined excimerlaser and topical tacrolimus for the treatment of vitiligo: a pilot study. Dermatol Surg. 2004 Feb;30(2 Pt 1):130–5.

• Mehrabi D, Pandya AG. A randomized, placebo-controlled, double-blind trial comparing narrowband UV-B Plus 0.1% tacrolimus ointment with narrowband UV-B plus placebo in the treatment of generalized vitiligo. Arch Dermatol. 2006 Jul;142(7):927–9.

• Lepe V, Moncada B, Castanedo-Cazares JP, et al. A double-blind randomized trial of 0.1% tacrolimus vs 0.05% clobetasol for the treatment of childhood vitiligo. Arch Dermatol. 2003 May;139(5):581–5.

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• Vitiligo

• Silverberg NB, Lin P, Travis L, et al. Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases. J Am Acad Dermatol. 2004 Nov;51(5):760–6.

• Fai D, Cassano N, Vena GA. Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol. 2007 Aug;21(7):916–20.

• Esfandiarpour I, Ekhlasi A, Farajzadeh S, et al. The efficacy of pimecrolimus 1% cream plus narrow-band ultraviolet B in the treatment of vitiligo: a double-blind, placebo-controlled clinical trial. J Dermatolog Treat. 2009 20(1):14–8.

• Ring J, Barker J, Behrendt H, et al. Review of the potential photo-cocarcinogenicity of topical calcineurin inhibitors: position statement of the European Dermatology Forum. J Eur Acad Dermatol Venereol. 2005 Nov;19(6):663–71.

Off label use• Campanati A, Brandozzi G, Giangiacomi M,

simonetti O, Marconi B, Offidani Am. Lichen striatus in adults and pimecrolimus: open, off-label clinical study. Int. J. Dermatol 2008; 47(7): 723-6

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• Lichen Striatus

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